Provider Demographics
NPI:1609240167
Name:ELAINE'S TRIO GROUP, LLC
Entity Type:Organization
Organization Name:ELAINE'S TRIO GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TU'SHEILA
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:210-446-8797
Mailing Address - Street 1:133 WILLOW VW
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2261
Mailing Address - Country:US
Mailing Address - Phone:210-446-8797
Mailing Address - Fax:
Practice Address - Street 1:512 BOWIE
Practice Address - Street 2:
Practice Address - City:UNIVERSAL CITY
Practice Address - State:TX
Practice Address - Zip Code:78148-4407
Practice Address - Country:US
Practice Address - Phone:210-446-8797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-20
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty